Healthcare Provider Details

I. General information

NPI: 1013919448
Provider Name (Legal Business Name): SPOT REHABILITATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W SAINT GERMAIN ST SUITE 300
SAINT CLOUD MN
56301-4743
US

IV. Provider business mailing address

2835 W SAINT GERMAIN ST SUITE 300
SAINT CLOUD MN
56301-4743
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4151
  • Fax: 320-259-5707
Mailing address:
  • Phone: 320-259-4151
  • Fax: 320-259-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH STEINESSEN
Title or Position: CEO
Credential: OTR/L
Phone: 320-259-4151